Journal of critical care
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To investigate microorganisms causing central venous catheter contamination and how this contamination differs across different catheter metrics. ⋯ This study found a high incidence of central access catheter hub bacterial contamination, which correlated with positive blood cultures in 2 of 3 total bacteremia cases identified in the 45 patients.
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Journal of critical care · Jun 2017
Clinical TrialThe accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure.
Dysphagia with subsequent aspiration occurs in up to 60% of acute respiratory failure (ARF) survivors. Accurate bedside tests for aspiration can reduce aspiration-related complications while minimizing delay of oral nutrition. In a cohort of ARF survivors, we determined the accuracy of the bedside swallowing evaluation (BSE) and its components for detecting aspiration. ⋯ ClinicalTrials.gov identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors.
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Journal of critical care · Jun 2017
The effect of targeted temperature management on QT and corrected QT intervals in patients with cardiac arrest.
Targeted Temperature Management (TTM) improves outcomes after cardiac arrest but may affect the QT and QTc intervals which could increase the chance of subsequent arrhythmia. We report here the effects of TTM on both computer-derived and manually calculated QT and QTc as well as the relationship of the length of the QTc and serious arrhythmia in a retrospective single-center experience. ⋯ QT and QTc prolong during TTM. There was no differential increase in the QTc in patients who experienced malignant arrhythmias. While the mechanism of QTc prolongation is not clear, it would not appear that the degree of QTc prolongation has an adverse effect on cardiac rhythm during TTM.
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Journal of critical care · Jun 2017
Comparative StudyNoninvasivepositive pressure ventilation vsinvasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure in cancer patients.
The objective was to describe the characteristics and outcomes of critically ill cancer patients who received noninvasive positive pressure ventilation (NIPPV) vs invasive mechanical ventilation as first-line therapy for acute hypoxemic respiratory failure. ⋯ Noninvasive positive pressure ventilation failure is an independent risk factor for ICU mortality, but NIPPV patients who avoided intubation had the best outcomes compared with the other groups. Early vs late intubation did not have a significant impact on outcomes.
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Journal of critical care · Jun 2017
Comparative Study Observational StudyOutcomes of nighttime refusal of admission to the intensive care unit: The role of the intensivist in triage.
To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. ⋯ Patients refused MICU admission overnight are more likely to be later admitted to an ICU than patients refused during the day. However, the mechanism for this observation does not appear to depend on the intensivist's direct evaluation of the patient. Further investigation into the clinician-specific effects of ICU triage and identification of potentially modifiable hospital triage practices will help to improve both ICU utilization and patient safety.